Specialization in Training and Human Resource Development
Supervisor’s Evaluation Form
University of Wisconsin-Stout Field Experience and Internship Programs
Communications, Education, and Training Department
I.
II.
TO BE COMPLETED BY STUDENT:
A.
Name
B.
Organization worked for
C.
Department worked in
D.
Dates of Employment: From
To
TO BE COMPLETED BY STUDENT’S IMMEDIATE SUPERVISOR ONCE EVERY FOUR WEEKS:
The purpose of this appraisal is to provide the university and the student an evaluation of their work
performance so as to assist the student in elective course selection, guidance, and overall personal
development. Please provide an honest appraisal of the intern by completing the information on this form.
A.
Overall appraisal of student’s performance:
1. Strengths:
2. Areas where improvement is needed:
B.
Describe any specific incidents to illustrate the previous overall appraisal:
Your discussion of this evaluation form with the student will be most helpful in identifying the reasons for
your evaluation, and in guiding the student in the future.
C. Please evaluate those traits which you are familiar with:
ABOVE
AVERAGE
AVERAGE
BELOW
AVERAGE
1. Quality of work
2. Judgment
3. Quantity of work
4. Dependability
5. Initiative
6. Rate of learning
7. Work habits
8. Ability to get along with others
Comments on above ratings:
D. Recommended course work or types of experiences which could improve student’s potential:
E. Have you discussed this evaluation with the student?
Yes
No
F. I certify that the student did perform the type of work and for the length of time as stated above.
SIGNATURE
DATE
TITLE
PHONE
University of Wisconsin-Stout
Communications, Education, and Training Department
APPLICATION FOR INTERNSHIP IN
TRAINING AND HUMAN RESOURCE DEVELOPMENT
Please Print or Type
1.
Personal Information
A.
Name
S.S.#
B.
Address while on internship
Street or Box Number
_________________________________
Phone Number
City, State, Zip
Fax
C.
E-mail
Home Address
Street or Box Number
II.
D.
Status:
Freshman
Sophomore
E.
Major
F.
Minor/Concentration/Specialization
Junior
Senior
Graduate
Internship Information
A.
Organization employing you
B.
Internship supervisor
Name and Title
C.
Organization’s Address
Street or Box Number
City, State, Zip
Phone Number
Fax
D.
Is this internship a paid position?
Yes
No
E.
Tentative dates of employment:
Start
End
F.
Numbers of hours you plan to work each week
G.
Have you been employed by the above employer previously?
If yes, when and in what capacity?
Yes
No
III. Objectives
A. Learning Objectives (These are just some suggestions. Use if applicable, but you need to list them here.)
1.
Perform or assist with training administrative duties.
2.
Manage or assist with on-going training activities.
3.
Conduct training needs assessment.
4.
Develop or assist in developing training programs and materials.
5.
Deliver training instruction using a combination of delivery techniques.
6.
Evaluate training programs or other training-related initiatives.
7.
Display effective interpersonal communication skills in carrying our the objectives of training.
B. Undergraduate Requirements
1.
2.
3.
4.
A list of major and minor learning objectives for the internship developed jointly between the
student, supervisor at the training site and Training Specialization Director at UW-Stout.
Word processed bi-weekly reports indicating a) the activities of two week periods, b) major
objectives covered, c) problems encountered, d) suggestions for solving problems, and e) projected
objectives for the following week(s). The bi-weekly reports will be sent via e-mail or mailed to Dr.
David A. Johnson (johnsondav@uwstout.edu).
Each month performance evaluations will be completed by the intern’s supervisor(s).
(See Supervisor’s Evaluation Form.)
One performance evaluation conducted by the UW-Stout Training Specialization Director or
designated coordinator at the completion of the internship.
Student Name
IV.
Soc. Sec.#
Application for
A.
Internship Course Information
1.
2.
3.
4.
B.
TRHRD-349/589/789, Training Internship
# of Credits
Term Enrolled
Including Credits noted in #2 above, how many training internship credits have you
completed?
Type of credit: Graduate
or Undergraduate
Are you attempting to satisfy a required course requirement in your major field with the above
internship? YES
V.
NO
Approval
A.
I accept the responsibility of coordinating and evaluating the above named student’s internship.
Signature of UW-Stout Training Specialization Director
Date
B.
I accept the responsibility of supervising the above named student’s internship at the site referenced
in II.C.
Signature of Internship Site Supervisor
C.
Date
I authorize the use of these internship credits in fulfilling requirements of the
(Degree Major, Minor or Specialization)
as
credit.
(Required, Elective, etc.)
Signature of Program/Specialization Director
Please return this approved application to:
Dr. David A. Johnson, Training Specialization Director,
143 Communication Technologies Building, UW-Stout 54751
Date
Internship Agreement
This is an agreement between UW-Stout and the organization, named below, in which a student intern,
also named below, will be placed. Appreciation is expressed for your help in assisting a student entering
the field of Training and Human Resource Development.
The following is a summary of our agreement:
1. The form “Application for Internship in Training and Human Resource Development” will be
completed by the intern and copies provided for the organization employing the intern and the Training
Specialization Director at UW-Stout.
2. The employing organization will provide experiences in the areas outlined in Part II of the form
“Application for Internship in Training and Human Resource Development.” When these experiences
cannot be provided, the objectives will be negotiated with Dr. David A. Johnson, the Training
Specialization Director at UW-Stout.
3. Bi-weekly reports will be prepared by the intern and approved by the intern’s supervisor. Each report
will contain (a) activities for that period of time, including major objectives completed; (b) problems
encountered and possible solutions to the problems; and (c) objectives for the next two weeks. Each
report will be typed and mailed or e-mailed to Dr. David A. Johnson, Training Specialization Director
at UW-Stout. johnsondav@uwstout.edu
4. The intern’s supervisor should complete the “Supervisor’s Evaluation Form” once every four weeks
and mail or e-mail it to Dr. David A. Johnson. johnsondav@uwstout.edu Note: This form can be
submitted more often should the need arise.
5. Upon completion of the internship, the UW-Stout internship coordinator will submit a grade to the UWStout, Registrar’s Office.
If you have any questions regarding the internship, please contact:
Dr. David A. Johnson, Training Specialization Director
Industrial Management Department
143 Communication Technologies Building
UW-Stout, 54751
Phone: 715-232-2143
Email: johnsondav@uwstout.edu
Johnson/Internship Form